Unit 12 GI Agents and Nutrition

Question 0

Antacids increase the absorption of Glyburide and can result in

Answer 0

Hypoglycemia.

Altering the timing of Glyburide administration can reduce this risk.

Question 1

Proton pump inhibitors increase gastric pH, interfering with the absorption of which drugs ?

Answer 1

Several cephalosporins and two azole antifungals: itraconazole and ketoconazole.

Question 2

Clopidogrel (Plavix) is a _______, requiring activation.

Answer 2

Prodrug

Question 3

The antiplatelet agent, clopidogrel has a major CYP interaction with which drugs ?

Answer 3

omeprazole (Prilosec)
esomeprazole (Nexium)

Suggestion: administer PPI 1 hr before breakfast and take Plavix at bedtime or use an H2 blocker to avoid the interaction all together.

Question 4

A patient presents with continuous and repetitive movements of the mouth, tongue, and jaw. You realize this is an adverse reaction to what antiemetics?

Answer 4

metoclopramide (Reglan) Black box warning!
prochlorperazine (Compazine)

Tardive dyskinesia!

Question 5

Antacids: Mechanism of Action

Answer 5

Weak base
Neutralize gastric hydrochloride acid
Cytoprotective effects
Do not “coat” mucosal lining

Question 6

GERD treatment principles :

Answer 6

1. Empirical therapy is appropriate with weight loss and diet control
2. Antacids, H2-receptor agonists, omeprazole available OTC. Don’t self medicate past 14 days.
3. Acid suppression - mainstay of therapy PPIs: First line drugs 1-2 mo

Question 7

H2-receptor antagonist/ H2-blockers are indicated for ;

Answer 7

(ranitidine, cimetidine, famotidine, nizatidine)
Duodenal ulcer tx. and maintenance 
Gastric ulcer tx.
GERD
Pathological hypersecretory conditions

Question 8

Proton Pump Inhibitors (PPIs) Indications for use :

Answer 8

(omeprazole, pantoprazole, etc)
Helicobacter pylori ! 
Gastric ulcers 
Duodenal ulcers 
GERD
Pathological hypersecretory conditions

Question 9

Histamine-2 Blockers and PPIs are ___________ agents.

Answer 9

Antisecretory

Question 10

H. Pylori ulcer treatment

Answer 10

Must be eradicated to prevent recurrence.
Prescribe H2-blocker or PPI PLUS antibiotic

D/C NSAIDs with ulcers

Question 11

H2- blockers it is important to monitor :

Answer 11

Liver enzymes and platelets

Renal function in elderly.

Question 12

Indications for laxatives :

Answer 12

Constipation
Prophylaxis of constipation
Surgical or procedural preparation
Expedited cleansing

Question 13

Non pharmacological treatment of constipation

Answer 13

Adequate fluid intake - 1500mL/day minimum
High fiber diet
Exercise
Regular toileting schedule

Question 14

Antidiarrheals are contraindicated in:

Answer 14

Bloody diarrhea
High fever
Systemic toxicity

Question 15

Antiemetics mechanism of action :

Answer 15

Act on vomiting center in the medulla

Indicated for motion sickness, N/V, vertigo

Question 16

Mechanism of action: antispasmodics/anticholinergics

Answer 16

Decrease motility, relax smooth muscle tone in GI tract, and decrease secretions.
Compete with acetylcholine for receptors at postganglionic fibers of parasympathetic nervous system.

Question 17

IBS treatment

Answer 17

Based on severity of symptoms.
Pain: antispasmotic short term or TCA long term
Diarrhea: Loperamide short term or TCAs long term, Alosetron if resistant to all other tx.
Constipation: Fiber and Laxatives

Question 18

Anorexiants mechanism of action

Answer 18

(Sibutramine, Phentermine, Orlistat)
Used for weight management
Indirect acting sympathomimetic amines
Direct stimulant effect of satiety center in hypothalamus